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Flashcards in Gross Anatomy Deck (127):
1

Mandible

Largest and strongest none of face
Consists of body, rami, coronoid process (temporalis muscle), and condyle

2

Mandibular foramen

Located on medial side of ramus under the lingula

IA nerve, artery, and vein

3

Mental foramen

Located below second premolars

Mental nerve (skin and mucous membrane)

Incisive nerve (pulp chambers of anterior teeth)

4

Scalp

S: skin (epidermis, dermis)
C: connective tissue (superficial fascia)
A: aponeurosis
L: loose connective tissue
P: periosteum

Dura mater
Arachnoid
Subarachnoid space
Cerebrum

5

What attaches to the lingula?

The sphenomandibular ligament

6

Epidural space

Potential space between periosteum and dura mater
Contains middle meningeal artery

Epidural hematoma = middle meningeal

7

Dura mater

Membranous outermost meninge that forms venous sinuses

Endosteal layer on periosteum side
Meningeal layer on brain side

8

Subdural space

Between dura and arachnoid
Contains bridging veins and venous sinuses

Subdural hematoma= bridging vein

9

Arachnoid

Weblike lattices between dura and pia

10

Subarachnoid space

Between arachnoid and pia

Filled with CSF

Contains Circle of Willis

Space entered with lumbar puncture

11

Vertical dura mater folds

Falx cerebri: separates left and right cerebral hemispheres; contains superiors and inferior sagittal sinuses

Falx cerebelli: separates cerebellum; contains occipital sinus

12

Horizontal dura mater folds

Tentorium cerebelli: separates cerebrum from cerebellum; contains straight, transverse, and superior petrosal sinuses
Uncus: medial parahippocampal gyrus

Diaphragma sella: roof of sella turcica

13

Dural sinuses

Superior sagittal
Inferior sagittal
Straight sinus
Cavernous sinus (2)
Superior petrosal sinus (2)
Inferior petrosal sinus (2)
Occipital sinus
Transverse sinus (2)
Confluence of sinuses
Sigmoid

14

Tributaries of dural sinuses

Emissary veins: drain scalp to dural sinuses

Diploic veins: drain diploe of skull to dural sinuses

Meningeal veins: drain meninges into dural sinuses

15

What major vessel drains the head and neck?

Internal jugular vein

16

Cavernous sinuses

Anterior: superior and inferior ophthalmic veins, pterygoid plexus
CNs 3, 6, V1, V2

Posterior: superior and inferior petrosal, intercavernous sinus
CN 6, ICA

17

What sinus connects the cavernous and sigmoid sinuses?

The superior petrosal sinus

18

Which nerve is the smallest and most medial in the cavernous sinus and will be the first affected by an infection or laterally expanding pituitary tumor?

CN VI

CV III and IV are also in this area

19

Pterygoid plexus of veins

Located in infratemporal fossa

Surrounds maxillary artery


Drains maxillary vein posteriorly and deep facial vein anteriorly (connects with anterior facial vein)

20

Ventricular system of brain

Ependymal cells line and produce CSF

Lateral ventricle near caudate nucleus
Inferior horn near hippocampus
Third ventricle near hypothalamus
Fourth ventricle near pons

Choroid plexus and ventricular system regulate intracranial pressure

21

CSF circulation

1. Lateral ventricles
2. Foramen of Monro
3. Third ventricle
4. Cerebral aqueduct
5. Fourth ventricle
6. Foramina of Magendie (medial) and Luschka (lateral)
7. Bathes cisterns in subarachnoid space
8. Arachnoid granulations into superior sagittal sinus to empty CSF into venous circulation

22

Where is CSF made?

Choroid plexus

Ependymal cells can also make CSF

23

Blood brain barrier

1. Blood CSF barrier: tight junctions in choroid plexus epithelial cells allow selective passage
2. Vascular endothelial barrier: tight junctions between endothelial cells
3. arachnoid barrier: arachnoid cells form a barrier to present substances from dural vessel from diffusing toward brain

24

Circle of Willis

Posterior cerebral artery
Posterior communicating artery
Internal carotid artery
Anterior cerebral artery
Anterior communicating artery

2 vertebral arteries and 2 carotid arteries

25

What arteries supply medial aspect of frontal and parietal lobes?

Right and left internal carotid arteries

Branch to anterior cerebral artery and middle cerebral artery

26

What supplies occipital cortex?

Basilar artery (convergence of left and right vertebral arteries)

Branches to posterior cerebral artery

27

Does the internal carotid artery have branches in the neck?

No

28

Vertebral arteries branch off of what?

Subclavian arteries

29

Middle cerebral artery

Largest branch of the ICA

Causes the most ischemic injury if blocked

Leticulostriate arteries, branches of MCA, are often involved in stroke and are thin walked and can rupture

30

Tongue Innervation

Motor: CN XII
Damage to CN XII causes tongue to deviate to the side damaged

Sensation: CN V3, IX, X

Taste: CN VII, IX, X

31

Even though the anterior 2/3, posterior 2/3 of tongue and epiglottis have different Innervation (CN VII, CN IX, and CN X respectively), where do their pathways converge?

Solitary tract to nucleus of solitary tract (gustatory nucleus)

Thalamic nucleus (VPM)

32

Chorda tympani nerve

Part of CN VII

Solitary tract nucleus, superior salivatory nucleus
Arises from geniculate ganglion, emerges from petrotympanic fissure, crosses tympanic membrane and joins lingual nerve (V3)

Taste to anterior 2/3 of tongue
Preganglionic parasympathetic synapse in submandibular ganglion

33

Inferior surface of tongue

Lingual frenulum: vertical fold in midline

Plica fimbriata: fold of mucous membrane lateral to frenulum

Wharton's and Rivian ducts: openings to submandibular and sublingual salivary glands

34

Types of tastebuds

Filiform: rough, avascular, no tastebuds, rough texture of tongue

Fungiform: mushroom shaped, contain tastebuds

Circumvallate: large circular structures with tastebuds

Foliate: lateral surface of tongue, nonfunctional

35

Muscles controlling the tongue

Bony attachments: genial tubercles, styloid process, and hyoid bone

Innervation of tongue muscles = CN XII (except palatoglossus)

Blood supply = lingual artery

36

Genioglossus muscle

O: genial tubercles
I: hyoid (inferior) and tongue (superior)
A: protrudes tongue
N: XII

37

Hyoglossus muscle

O: hyoid
I: side of tongue medial to styloglossus
A: depress tongue, pulls down side
N: XII

38

Styloglossus muscle

O: styloid process
I: side of tongue
A: pulls tongue up and back
N: XII

39

Palatoglossus muscle

O: anterior soft palate
I: side and dorsum of tongue
A: pulls tongue up and back
N: X

40

Intrinsic tongue muscles

Longitudinal: shorten tongue, make dorsum convex (inferior) or concave (superior)

Transversus: narrow and elongate tongue

Verticalis: flattens and broadens the tongue

41

Speaking sounds:

"La la"

"Mi mi"

"Kuh kuh"

CN XII moved tongue against roof of mouth

CN VII moves lips

CN X raises palate

42

Hyoglossus muscle relationships

Medial to = lingual artery

Lateral to = lingual vein, nerve, submandibular duct, hypoglossal nerve

43

Palate nerve, blood supply

Motor Innervation: pharyngeal plexus
Sensory Innervation: V2 (greater palatine posteriorly, nasopalatine anteriorly)

Blood supply: third part of maxillary artery (branch of ECA)

44

Palatial salivary glands

Mostly mucous

Located beneath mucous membrane if hard and soft palate

45

Hard palate components

Maxillary bone (palatine processes)

Palatine bones (horizontal plates)

Covered with keratinized mucosa

Palatial salivary glands beneath mucosa

46

Soft palate components

Muscles: palatopharyngeus, palatoglossus, levator veli palatini, tensor veli palatini; uvular

Covered by non-keratinized mucosa

Anterior zone of sub mucosa contains fat
Posterior zone contains mucous glands

Palatal aponeurosis: fibrous connective tissue over muscles

47

Soft palate attachments

To the tongue: palatoglossus arches (anterior pillar)
Palatoglossus draws tongue and soft palate together, narrows isthmus of fauces

To the pharynx: palatopharyngeal arches (posterior pillar)
Palatopharyngeus elevated pharynx, closes nasopharynx and aids in swallowing

48

Uvula

Suspended from soft palate

Bifid uvula from incomplete fusion of palatine shelves

Unilateral damage to pharyngeal plexus causes uvula to deviate contralaterally (pulled to functional side)

49

Fauces

Fauces are between anterior and posterior pillars

House the palatine tonsils

50

Tonsils

Pharyngeal: located on nasopharynx and do not have lymph, sinuses not crypts

Palatine: located in isthmus if fauces and contain crypts and lymphoid follicles, but no sinuses

Lingual: located in dorsum of tongue and contain lymphoid follicles each with a single crypt

51

Waldeyer's ring

Ring of lymphoid tissue

Lingual tonsil inferiorly
Palatine tonsils laterally
Nasopharyngeal tonsils superiorly

52

Which two muscles prevent food from entering the nasopharynx during swallowing?

Tensor and levator veli palatini

53

Tensor vs levator veli palatini

Tensor: origin on greater wing of sphenoid, insertion on hamulus and palatal aponeurosis, tenses palate and opens auditory tube, innervated by V3

Levator: origin on inferior petrous temporal bone, inserts on palatine aponeurosis, elevates and raises palate, innervated by CN X

54

What two muscles meet at the pterygomandibular raphe?

Buccinator and superior pharyngeal constructor

55

Pharyngeal muscles - constrictors

Superior, middle, inferior and cricopharyngeus

Contract in waves to propel food

Sensory Innervation from CN X
Motor from CN XI

56

Pharyngeal muscles - longitudinal muscles

Palatopharyngeus: raises pharynx and larynx during swallowing (CN XI)

Salpingopharyngeus: elevates nasopharynx and opens auditory tube to equalize pressure (CN XI)

Stylopharyngeus: raises pharynx and larynx during swallowing (CN IX)

57

Which nerves comprise the pharyngeal plexus?

CN IX, X and XI

Innervated constrictors, palatoglossus, Palatopharyngeus, and cricopharyngeus

58

What is the only muscle innervated by CN IX?

Stylopharyngeus

59

Three phases of swallowing

1. Oral phase: moisten, masticate (CN V), trough tongue (CN XII), voluntary movement of bolus

2. Pharyngeal phase: close nasopharynx via tensor veli palatini (CN V) and levator veli palatini (CN X), elevate pharynx and hyoid via style pharyngeus, salpingopharyngeus and Palatopharyngeus (CN IX and X); close pharynx, retroversion of epiglottis, adduction of vocal cords; bolus passes through and constrictors go though wavelike contraction

3. Esophageal phase: esophageal peristalsis (CN X) and relaxation

60

During swallowing, where can food get caught?

Vallecula or pyriform recess

61

Nasolacrimal apparatus

Lacrimal gland: produces tears
Lacrimal puncta: collects tears and drains to lacrimal canals
Lacrimal canals join lacrimal sac which drains down nasolacrimal duct
Nasolacrimal duct empties underneath inferior nasal concha into inferior meatus

62

Lacrimal gland

Paired serous glands involved in tear production

Parasympathetic Innervation via superior salivatory nucleus, greater petrosal nerve (CN VII), and lacrimal nerve (CN VI)

63

Lymphatic drainage of oral cavity

Parotid gland through parotid nodes then to superior deep cervical nodes

Submandibular and sublingual through submandibular and deep cervical nodes

64

What major vessel supplies all salivary glands?

External carotid artery

65

Parotid gland

Serous secretion

Stenson's (parotid) duct

Pre ganglionic Innervation from lesser petrosal nerve (CN IX) synapse in otic ganglion, post ganglionic innervation with auriculotemporal nerve (V3)

Superficial temporal artery and facial artery supply blood

66

Submandibular gland

Serous and mucous secretion

Wharton's (submandibular) duct
Empties at sublingual caruncle

Pre ganglionic via chorda tympani (CN VII), synapses at submandibular ganglion, postganglionic goes to gland

Blood supply from facial artery

67

Submandibular gland

Mucous secretion

Sublingual (Rivian) ducts
Open directly into oral cavity in sublingual fold

Pre ganglionic via chorda tympani (CN VII), synapses at submandibular ganglion, postganglionic at gland

Blood supply from lingual artery

68

Minor salivary glands

Labial and buccal: mucous only

Von ebners glands: serous only

Glands of Blandin-Nuhn: mixed serous mucous

69

Which gland emits the highest volume of salivary fluid per day?

Submandibular gland

Parotid is second

70

Mastication

Process of biting and chewing food to make it soft to swallow

71

Muscles of mastication

Masseter
Temporalis
Medial and lateral pterygoid

All innervated by CN V3

Accessory muscles: supra- and infrahyoids

Tongue and buccinator are crucial for controlling bolus (CN XII and VII respectively)

72

A left subcondylar fracture will deviate the mandible to which side?

The left because only the right lateral pterygoid is functional

73

Masseter muscle

O: superficial head on zygomatic process of maxilla and zygomatic arch, deep head on inner zygomatic arch
I: superficial head on angle of mandible, deep head on lateral ramus
A: elevation and retrusion
N: V3

74

Temporalis muscle

O: temporal fossa
I: medial coronoid process
A: retrusion and elevation, ipsilateral excursion
N: V3

75

Medial Pterygoid muscle

O: medial side of lateral pterygoid plate
I: medial mandible angle
A: elevation, some contralateral excursion and protrusion
N: V3

76

Lateral pterygoid muscle

O: superior head on greater wing of sphenoid, inferior head on lateral side of lateral pterygoid plate
I: superior head on articular capsule and disc, inferior head on condylar neck
A: protrusion, depression, contralateral excursion
N: V3

77

Which muscles are involved in jaw opening?

Lateral pterygoids, suprahyoids, infrahyoids

78

Which muscles are involved in jaw closing?

Temporalis, masseter, medial pterygoids

79

Which muscles are responsible for jaw protrusion?

Pterygoid muscles

80

Which muscles are responsible for jaw retrusion?

Temporalis, masseter (deep)

81

Which muscles are responsible for jaw excursion?

Contralateral pterygoid muscles, ipsilateral masseter and temporalis

82

TMJ

Bilateral synovial joint
Upper compartment = translation
Lower compartment = rotation

83

TMJ components

Glenoid/mandibular fossa of temporal bone
Articular cartilage
Disc
Condylar cartilage cap
Condyle of mandible

Articular capsule surrounds joint with synovium internally

84

What type of cartilage covers articular surfaces of the TMJ?

Fibrocartilage

Not hyaline as is seen in most synovial joints

85

Nerves of TMJ

Auriculotemporal nerve (V3): pain in capsule and parasympathetic Innervation to parotid gland

Nerve to masseter (V3): anterior TMJ

Posterior deep temporal nerve (V3): anterior TMJ

86

TMJ ligaments

Temporomandibular: oblique portion prevents posterior and inferior displacement, horizontal portion prevents lateral displacement

Sphenomandibular: remnant of Meckel's cartilage that connects sphenoid with mandible lingula

Stylomandibular: connects styloid to angle of mandible

87

What is the only direction the TMJ can be dislocated?

Anteriorly

Luxation requires assistance
Subluxation auto-reduces

The disc can be pulled or torn anteromedially by the lateral pterygoid

88

How to reduce a luxated TMJ

Stand behind patient with thumbs on occlusal surface and fingers below chin

Push inferiorly with thumbs while fingers close mandible

Condylar head will slide back into articular fossa

89

TMJ noises

Click: with anterior disc displacement
Opening: disc clicks over anteriorly moving condyle
Closing: condyle moves posteriorly past disc

Crepitus: associated with osteoarthritis

Dull thud: self-reducing subluxation of condyle

90

Six TMJ movements

Protrusion
Retrusion
Opening
Closing
Medial excursion
Lateral excursion

91

What is the normal range of motion for TMJ opening, protrusively, and laterally ?

50mm open
10mm protrusively
10mm laterally

92

Cervical vertebrae

C1-C7

C1 = atlas
C2 = axis

Transverse foramina allow passage of vertebral artery to form basilar

93

Atlanto occipital joint

Between C1 and atlas

Allows head to nod yes (flexion and extension)

94

Atlanto axial joint

Between C1 and C2

Allows head to shake no (pivot)

95

Platysma muscle

Innervated by CN VII
Blends with orbicularis oris

Superficial to deep cervical fascia

96

Investing layer of deep cervical fascia contains what muscles and glands?

Sternocleidomastoid, trapezius

Submandibular and parotid glands

97

Pre tracheal later of deep cervical fascia contains what?

Thyroid gland
Larynx
Pharynx
Esophagus

98

Prevertebral layer of deep cervical fascia contains what?

Vertebrae and deep cervical muscles

The prevertebral layer is why the thyroid moves with laryngeal muscles ??? Maybe pretracheal

99

Contents of the carotid sheath

Common carotid artery
Internal jugular vein
CN X

Also lymph nodes, carotid sinus nerve, sympathetic nerves

100

Retropharyngeal space

Between pharynx and prevertebral fascia

Concern for infection spread because it connects with mediastinum

101

Posterior triangle of the neck

Anterior - SCM
Posterior - Trapezius
Inferior - clavicle
Floor - splenius capita, levator scapulae, and scalene muscles
Roof: skin, superficial fascia and platysma, deep investing fascia

Contains cervical plexus, great auricular nerve, lesser occipital nerve, subclavian vein, artery, brachial plexus

102

Anterior triangle of the neck

Anterior - neck midline
Posterior - SCM
Inferior - inferior border of mandible
Floor - pharynx, larynx, thyroid
Roof - skin, superficial fascia and platysma, deep investing fascia

Contains infrahyoids, suprahyoids, common/internal/external carotids, internal/external jugular veins, retro mandibular vein, CN X, XI and XII

103

Submandibular triangle (part of anterior triangle)

Inferior - Digastric
Superior - inferior mandible
Floor - mylohyoid and hyoglossus
Roof - same

Contains submandibular gland, submandibular lymph nodes, hyoglossal nerve, mylohyoid nerve, lingual and facial arteries and veins

104

Muscular triangle (part of anterior triangle)

Superior border of omohyoid
SCM
Midline of neck

Contains infrahyoid strap muscles

105

Carotid triangle (part of anterior triangle)

Superior belly of omohyoid
Posterior belly of digastric
SCM

Contains common carotid, internal jugular vein, CNs X, XI, XII, cervical plexus

106

Sub mental triangle (part of anterior triangle)

Right and left anterior bellies of digastric
Body of hyoid

Contains mylohyoid muscle

107

What muscles are innervated by the ansa cervicalis?

Sternohyoid
Sternothyroid
Omohyoid

Thyrohyoid is innervated by C1 via CN XII

108

Sternocleidomastoid muscle

O: manubrium, clavicle
I: mastoid process
A: flexes neck bilaterally, pulls head to shoulder and turns head to opposite side unilaterally
N: CN XI

109

Trapezius muscle

O: thoracic and cervical spine, ligamentum nucha, superior nuchal line
I: scapula, lateral clavicle
A: extends head bilaterally, elevates shoulder and pulls chin to opposite side unilaterally
N: CN XI

110

Hyoid bone

U shaped floating bone

Composed of body, greater and lesser horns

111

Torticollis (head tilting to the affected side) results from injury to what muscle?

SCM

112

Ligaments attaching to hyoid

Stylohyoid
Hypoepiglottic

113

Muscles attaching to hyoid

Mylohyoid (CN V3)
Anterior digastric (CN V3)
Posterior digastric (CN VII)
Stylohyoid (CN VII)
Hypoglossus (CN XII)
Geniohyoid (C1 via XII)
Omohyoid (ansa cervicalis)
Sternohyoid (ansa cervicalis)
Thyrohyoid (C1 via XII)

114

Digastric muscle

O: anterior head on intermediate tendon, posterior head on temporal bone
I: anterior head on anterior mandible, posterior head on intermediate tendon
A: raises hyoid
N: anterior head V3, posterior head CN VII

115

Mylohyoid muscle

O: medial mandible (mylohyoid line)
I: median raphe, body of hyoid
A: raises hyoid, base of tongue, FOM
N: V3

116

Geniohyoid

O: genial tubercles
I: body of hyoid
A: raises hyoid
N: C1 via CN XII

117

Stylohyoid muscle

O: stylohyoid process
I: greater horn of hyoid
A: raises hyoid
N: CN VII

118

Omohyoid muscle

O: superior belly on intermediate tendon, inferior belly on superior scapula
I: superior belly on hyoid, inferior belly On intermediate tendon
A: depresses hyoid and larynx
N: ansa cervicalis

119

Sternohyoid muscle

O: manubrium of sternum
I: hyoid
A: depress hyoid and larynx
N: ansa cervicalis

120

Sternothyroid

O: manubrium of sternum
I: thyroid cartilage
A: depress larynx
N: ansa cervicalis

121

Thyrohyoid

O: thyroid cartilage
I: hyoid
A: depresses hyoid and larynx
N: C1 via CN XII

122

Cervical plexus

C1-C4
Cutaneous Innervation to skin of neck, shoulder, and anterior upper chest wall
Motor to infrahyoid muscles and geniohyoid
Phrenic nerve (C3, 4, 5) is contributed in part by ansa cervicalis
Supraclavicular nerves innervated skin over shoulder
Transverse cervical nerve carries sensory Innervation to anterior and lateral neck

123

Ansa cervicalis

Motor division of cervical plexus
Comes from C1 and runs with CN XII

Innervates infrahyoids (except thyrohyoid), geniohyoid

124

Branches of C2, C3 loop (sensory)

Lesser occipital nerve (C2): skin of neck and scalp

Great auricular nerve (C2, 3): skin over parotid gland, posterior auricle, mandible to mastoid

Transverse cervical nerve (C2, 3): skin of anterior triangle

125

Phrenic nerve

C3, 4, 5

Contains motor, sensory, and sympathetic nerve fibers

Sole motor Innervation to diaphragm

126

External carotid artery branches

Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery
Maxillary artery (terminal branch)
Superficial temporal branch (terminal)

127

What does the ECA supply?

Face
Thyroid
Salivary gland
Tongue
Jaws
Teeth
Carotid sinus (baroreceptors)
Carotid body (chemoreceptors)